Evidence Based Medicine on FHIR Implementation Guide
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Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions

: ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Evidence ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "104098"] ; # 
  fhir:meta [
fhir:versionId [ fhir:v "14" ] ;
fhir:lastUpdated [ fhir:v "2023-12-06T17:20:30.903Z"^^xsd:dateTime ] ;
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/uv/ebm/StructureDefinition/comparative-evidence>     ] [
fhir:v "http://hl7.org/fhir/uv/ebm/StructureDefinition/single-study-evidence"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/uv/ebm/StructureDefinition/single-study-evidence>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Evidence 104098</b></p><a name=\"104098\"> </a><a name=\"hc104098\"> </a><a name=\"104098-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">version: 14; Last updated: 2023-12-06 17:20:30+0000</p><p style=\"margin-bottom: 0px\">Profiles: <a href=\"StructureDefinition-comparative-evidence.html\">ComparativeEvidence</a>, <a href=\"StructureDefinition-single-study-evidence.html\">SingleStudyEvidence</a></p></div><p><b>url</b>: <a href=\"https://fevir.net/resources/Evidence/104098\">https://fevir.net/resources/Evidence/104098</a></p><p><b>identifier</b>: FEvIR Object Identifier/104098</p><p><b>name</b>: ComparativeEvidence_Bypass_surgery_effects_on_Myocardial_infarction_or_stroke_in_Swedish_Obese_Subjects_SOS_study</p><p><b>title</b>: ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study</p><p><b>status</b>: Active</p><p><b>date</b>: 2022-09-19 21:15:57+0000</p><p><b>publisher</b>: Computable Publishing LLC</p><p><b>contact</b>: <a href=\"mailto:support@computablepublishing.com\">support@computablepublishing.com</a></p><p><b>author</b>: Brian S. Alper: </p><p><b>copyright</b>: </p><div><p>https://creativecommons.org/licenses/by-nc-sa/4.0/</p>\n</div><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: Derived From</p><h3>Documents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"https://jamanetwork.com/journals/jama/fullarticle/1103994\">https://jamanetwork.com/journals/jama/fullarticle/1103994</a></td></tr></table></blockquote><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: Cite As</p><p><b>citation</b>: </p><div><p>ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study [Evidence]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104098. Revised 2022-09-19. Available at: https://fevir.net/resources/Evidence/104098. Computable resource at: https://fevir.net/resources/Evidence/104098.</p>\n</div></blockquote><p><b>description</b>: </p><div><p>Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P &lt; .001). -- Extrapolated from this data the outcome of Nonfatal myocardial infarction or stroke occurred in 188 out of 2037 patients in the control group and 171 out of 2010 patients in the surgery group, and the adjusted HR for total events is assumed to apply (adjusted HR 0.67, 95% CI 0.54 to 0.83)</p>\n</div><p><b>assertion</b>: </p><div><p>Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.</p>\n</div><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women.  All in Sweden.</p>\n</div><p><b>variableRole</b>: Population</p></blockquote><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>bariatric surgery vs. usual care without bariatric surgery</p>\n</div><p><b>variableRole</b>: Exposure</p><p><b>comparatorCategory</b>: no bariatric surgery</p><p><b>intended</b>: <a href=\"EvidenceVariable-172427.html\">GroupAssignment: Bariatric Surgery vs. no bariatric surgery</a></p></blockquote><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: </p><div><p>nonfatal myocardial infarction or stroke</p>\n</div><p><b>variableRole</b>: Outcome</p><p><b>observed</b>: <a href=\"EvidenceVariable-104097.html\">OutcomeVariable: Nonfatal myocardial infarction or stroke</a></p></blockquote><p><b>synthesisType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/synthesis-type NotApplicable}\">not applicable</span></p><p><b>studyDesign</b>: <span title=\"Codes:{http://hl7.org/fhir/study-design SEVCO:01002}\">Observational research</span>, <span title=\"Codes:{http://hl7.org/fhir/study-design SEVCO:01011}\">Parallel cohort design</span>, <span title=\"Codes:{http://hl7.org/fhir/study-design SEVCO:01014}\">Matching for comparison</span>, <span title=\"Codes:{http://hl7.org/fhir/study-design SEVCO:01028}\">Longitudinal data collection</span></p><blockquote><p><b>statistic</b></p><p><b>description</b>: </p><div><p>Hazard ratio, adjusted 0.67; 95% CI 0.54 to 0.83</p>\n</div><p><b>note</b>: The event rates are calculated from the reported total (fatal and nonfatal events) minus the fatal events. Nonfatal myocardial infarction or stroke occurred in 188 out of 2037 patients in the control group and 171 out of 2010 patients in the surgery group, and the adjusted HR for total events is assumed to apply (adjusted HR 0.67, 95% CI 0.54 to 0.83)</p><p><b>statisticType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/statistic-type C93150}\">Hazard Ratio</span></p><p><b>quantity</b>: 0.67</p><p><b>numberAffected</b>: 359</p><h3>SampleSizes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>NumberOfParticipants</b></td><td><b>KnownDataCount</b></td></tr><tr><td style=\"display: none\">*</td><td>4047</td><td>4047</td></tr></table><h3>AttributeEstimates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Description</b></td><td><b>Type</b></td><td><b>Level</b></td><td><b>Range</b></td></tr><tr><td style=\"display: none\">*</td><td><div><p>95% CI 0.54 to 0.83</p>\n</div></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/attribute-estimate-type C53324}\">Confidence interval</span></td><td>0.95</td><td>0.54-0.83</td></tr></table><h3>ModelCharacteristics</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{https://fevir.net/resources/CodeSystem/181513 TBD:0000120}\">Adjusted analysis</span></td></tr></table></blockquote><h3>Certainties</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Rating</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://hl7.org/fhir/certainty-type Overall}\">Overall certainty</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/certainty-rating low}\">Low quality</span></td></tr></table></div>"
  ] ; # 
  fhir:url [ fhir:v "https://fevir.net/resources/Evidence/104098"^^xsd:anyURI] ; # 
  fhir:identifier ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ACSN" ] ;
fhir:display [ fhir:v "Accession ID" ]       ] ) ;
fhir:text [ fhir:v "FEvIR Object Identifier" ]     ] ;
fhir:system [ fhir:v "https://fevir.net"^^xsd:anyURI ] ;
fhir:value [ fhir:v "104098" ] ;
fhir:assigner [
fhir:display [ fhir:v "Computable Publishing LLC" ]     ]
  ] ) ; # 
  fhir:name [ fhir:v "ComparativeEvidence_Bypass_surgery_effects_on_Myocardial_infarction_or_stroke_in_Swedish_Obese_Subjects_SOS_study"] ; # 
  fhir:title [ fhir:v "ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:date [ fhir:v "2022-09-19T21:15:57.338Z"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "Computable Publishing LLC"] ; # 
  fhir:contact ( [
    ( fhir:telecom [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "support@computablepublishing.com" ]     ] )
  ] ) ; # 
  fhir:author ( [
fhir:name [ fhir:v "Brian S. Alper" ]
  ] ) ; # 
  fhir:copyright [ fhir:v "https://creativecommons.org/licenses/by-nc-sa/4.0/"] ; # 
  fhir:relatedArtifact ( [
fhir:type [ fhir:v "derived-from" ] ;
fhir:document [
fhir:url [ fhir:v "https://jamanetwork.com/journals/jama/fullarticle/1103994"^^xsd:anyURI ]     ]
  ] [
fhir:type [ fhir:v "cite-as" ] ;
fhir:citation [ fhir:v "ComparativeEvidence: Bypass surgery effects on Myocardial infarction or stroke in Swedish Obese Subjects (SOS) study [Evidence]. Contributors: Brian S. Alper [Authors/Creators]. In: Fast Evidence Interoperability Resources (FEvIR) Platform, FOI 104098. Revised 2022-09-19. Available at: https://fevir.net/resources/Evidence/104098. Computable resource at: https://fevir.net/resources/Evidence/104098." ]
  ] ) ; # 
  fhir:description [ fhir:v "Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P < .001). -- Extrapolated from this data the outcome of Nonfatal myocardial infarction or stroke occurred in 188 out of 2037 patients in the control group and 171 out of 2010 patients in the surgery group, and the adjusted HR for total events is assumed to apply (adjusted HR 0.67, 95% CI 0.54 to 0.83)"] ; # 
  fhir:assertion [ fhir:v "Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults."] ; # 
  fhir:variableDefinition ( [
fhir:description [ fhir:v "Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women.  All in Sweden." ] ;
fhir:variableRole [ fhir:v "population" ]
  ] [
fhir:description [ fhir:v "bariatric surgery vs. usual care without bariatric surgery" ] ;
fhir:variableRole [ fhir:v "exposure" ] ;
fhir:comparatorCategory [ fhir:v "no bariatric surgery" ] ;
fhir:intended [
fhir:reference [ fhir:v "EvidenceVariable/172427" ] ;
fhir:type [ fhir:v "EvidenceVariable"^^xsd:anyURI ] ;
fhir:display [ fhir:v "GroupAssignment: Bariatric Surgery vs. no bariatric surgery" ]     ]
  ] [
fhir:description [ fhir:v "nonfatal myocardial infarction or stroke" ] ;
fhir:variableRole [ fhir:v "outcome" ] ;
fhir:observed [
fhir:reference [ fhir:v "EvidenceVariable/104097" ] ;
fhir:type [ fhir:v "EvidenceVariable"^^xsd:anyURI ] ;
fhir:display [ fhir:v "OutcomeVariable: Nonfatal myocardial infarction or stroke" ]     ]
  ] ) ; # 
  fhir:synthesisType [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/synthesis-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NotApplicable" ] ;
fhir:display [ fhir:v "not applicable" ]     ] )
  ] ; # 
  fhir:studyDesign ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/study-design"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SEVCO:01002" ] ;
fhir:display [ fhir:v "Observational research" ]     ] )
  ] [
    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/study-design"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SEVCO:01011" ] ;
fhir:display [ fhir:v "Parallel cohort design" ]     ] )
  ] [
    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/study-design"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SEVCO:01014" ] ;
fhir:display [ fhir:v "Matching for comparison" ]     ] )
  ] [
    ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/study-design"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SEVCO:01028" ] ;
fhir:display [ fhir:v "Longitudinal data collection" ]     ] )
  ] ) ; # 
  fhir:statistic ( [
fhir:description [ fhir:v "Hazard ratio, adjusted 0.67; 95% CI 0.54 to 0.83" ] ;
    ( fhir:note [
fhir:text [ fhir:v "The event rates are calculated from the reported total (fatal and nonfatal events) minus the fatal events. Nonfatal myocardial infarction or stroke occurred in 188 out of 2037 patients in the control group and 171 out of 2010 patients in the surgery group, and the adjusted HR for total events is assumed to apply (adjusted HR 0.67, 95% CI 0.54 to 0.83)" ]     ] ) ;
fhir:statisticType [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/statistic-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C93150" ] ;
fhir:display [ fhir:v "Hazard Ratio" ]       ] )     ] ;
fhir:quantity [
fhir:value [ fhir:v "0.67"^^xsd:decimal ]     ] ;
fhir:numberAffected [ fhir:v "359"^^xsd:nonNegativeInteger ] ;
fhir:sampleSize [
fhir:numberOfParticipants [ fhir:v "4047"^^xsd:nonNegativeInteger ] ;
fhir:knownDataCount [ fhir:v "4047"^^xsd:nonNegativeInteger ]     ] ;
    ( fhir:attributeEstimate [
fhir:description [ fhir:v "95% CI 0.54 to 0.83" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/attribute-estimate-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "C53324" ] ;
fhir:display [ fhir:v "Confidence interval" ]         ] )       ] ;
fhir:level [ fhir:v "0.95"^^xsd:decimal ] ;
fhir:range [
fhir:low [
fhir:value [ fhir:v "0.54"^^xsd:decimal ]         ] ;
fhir:high [
fhir:value [ fhir:v "0.83"^^xsd:decimal ]         ]       ]     ] ) ;
    ( fhir:modelCharacteristic [
fhir:code [
        ( fhir:coding [
fhir:system [ fhir:v "https://fevir.net/resources/CodeSystem/181513"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TBD:0000120" ] ;
fhir:display [ fhir:v "Adjustment for covariates" ]         ] ) ;
fhir:text [ fhir:v "Adjusted analysis" ]       ]     ] )
  ] ) ; # 
  fhir:certainty ( [
fhir:type [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/certainty-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "Overall" ] ;
fhir:display [ fhir:v "Overall certainty" ]       ] )     ] ;
fhir:rating [
      ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/certainty-rating"^^xsd:anyURI ] ;
fhir:code [ fhir:v "low" ] ;
fhir:display [ fhir:v "Low quality" ]       ] )     ]
  ] ) . #